Use of the child and adolescent functional assessment scale (CAFAS) as an outcome measure in clinical settings

Abstract

This article discusses how the Child and Adolescent Functional Assessment Scale (CAFAS) can be used as an outcome measure in clinical settings. Outcome data from two clinical samples are provided: a small community mental health center located in Michigan and a large referred sample from the Fort Bragg Evaluation Project. Outcome indicators for assessing change over time included overall level of dysfunction, percentage of respondents with severe impairment, mean total score, mean scores for individual CAFAS subscales, and change in total score at the client level. Implications of the findings were discussed from several perspectives: improving services to individual clients, developing databases at the local level that can be used for the agency's continuing self-scrutiny, and pooling databases across sites that can be used to study broader issues within a managed care environment.

Epidemiology of Psychiatric Disability in Childhood and Adolescence

“…We can still maintain the separation between health conditions '' inferred '' from impairments of function and structure and their resultant activity limitations and participation restrictions, because, even in psychiatry, neither activity limitations nor participation restrictions are logically necessary requirements for making most diagnoses (as Spitzer & Wakefield, 1999, amply demonstrate in their critique of DSM-IV's practice in this regard). Indeed, several empirical studies have indicated that psychiatric symptoms and measures of what ICIDH-2 would call limitations and restrictions tap meaningfully different dimensions of dysfunction, which independently predict a variety of outcomes, including service use and prognosis (Costello, Angold, & Keeler, 1999 ;Costello, Angold, Messer, & Farmer, 1996 ;Green, Shirk, Hanze, & Wasntrath, 1994 ;Hodges & Wong, 1997 ;Hodges, Wong, & Latessa, 1998 ;Lavigne et al, 1998 ;Lyons et al, 1997 ;McArdle & Gillett, 1997 ;Settertobulte & Kolip, 1997 ;Shaffer et al, 1983 ;Verhulst et al, 1993). Maintaining a distinction between diagnosis (usually identified on the basis of impairments of psychological functions) and other dimensions of disability also enables us to investigate the interplay between the two (Ezpeleta, Granero, de la Osa, & Guillamon, 2000 ;Hodges, Doucette-Gates, & Liao, 1999) over time, and from a developmental perspective it is far from obvious that we should expect to see unidirectional causal arrows from disorder to disability.…”

Neural Changes Associated with Treatment Outcome in Children with Externalizing Problems

“…A decrease of 20 points or more is considered clinically significant improvement (Hodges & Wong Latessa, 1998). On the basis of these measures, 32 children were classified as improvers and 39 children were classified as nonimprovers.…”

“…To rate the child, the clinician collects information from multiple informants in different settings, including the child's parents, teachers, and other significant adults (e.g., grandparent, school counselor). The reliability and validity of the instrument have been well established (Hodges & Gust, 1995;Hodges & Wong, 1996) and it is particularly sensitive to clinical change over time (Hodges, 1999;Hodges, Wong, & Latessa, 1998;Hodges & Wong, 1996). For assessing improvement status, I focused on four CAFAS scales: school, home, community, and behaviour toward others (Hodges & Wong, 1996).…”

“…Group classification: In terms of a group classification for improvers and nonimprovers, I focused on four CAFAS scales: school, home, community, and behaviour toward others (Hodges Wong, 1996, Hodges Wong, Latessa 1998Hodges, 1999). A decrease of 20 points or more is considered clinically significant improvement (Hodges & Wong Latessa, 1998).…”

Online Problem-Solving Therapy After Traumatic Brain Injury: A Randomized Controlled Trial

“…20 The CAFAS generates ratings of functioning in 8 domains: school, home, community, behavior toward others, moods/ emotions, self-harmful behaviors, substance abuse, and thinking. 32 Functioning in each domain is rated on an ordinal scale ranging from 0 (no impairment) to 30 (severe impairment) in increments of 10. A total score is created by summing domain scores.…”